Healthcare Provider Details

I. General information

NPI: 1750480497
Provider Name (Legal Business Name): KATHRYN AYERS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 WASHINGTON PL CHESTERBROOK
CHESTERBROOK PA
19087-5868
US

IV. Provider business mailing address

521 WASHINGTON PL CHESTERBROOK
CHESTERBROOK PA
19087-5868
US

V. Phone/Fax

Practice location:
  • Phone: 610-993-3112
  • Fax:
Mailing address:
  • Phone: 610-993-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS-006199-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: